Precht Clarissa, Demirel Yeliz, Assaf Alexandre T, Pinnschmidt Hans O, Knipfer Christian, Hanken Henning, Friedrich Reinhard E, Wikner Johannes
Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
In Vivo. 2019 May-Jun;33(3):855-862. doi: 10.21873/invivo.11550.
The purpose of this study was to survey the current opinions of hospitals and medical practices concerning the perioperative management of patients undergoing direct oral anticoagulant therapy (DOAC) and discuss recommendations for the clinical practice.
A questionnaire with 13 topics and multiple ordinal-polytomous subitems was designed and sent to 120 Departments of Oral and Maxillofacial Surgery in Austria, Switzerland and Germany, as well as to 85 oral and maxillofacial/oral surgeons in medical offices in Hamburg, Germany. The data were statistically evaluated by Chi-square, Fisher's exact and Jonckheere-Terpstra tests.
The rate of response was 42%. Thirty-seven percent of respondents reported treating over 50 patients per year with undergoing DOAC therapy and only 18% assess a high bleeding risk [33% for vitamin K antagonists (VKA)]. In contrast to that, 62% of respondents would interrupt the DOAC therapy for extraction of one tooth, while 94% would continue VKA therapy. Significantly more clinicians apply suture than those in a medical office. The use of additional hemostatic measures varied between clinic and medical practice. There was a clear request for more detailed guidelines.
The study shows the current opinion for perioperative management of patients undergoing DOAC therapy. Multi-centric studies under controlled conditions are needed for a safer treatment of anticoagulated patients as therapy strategies differ greatly between institutions and therefore a complication analysis is hardly possible.
本研究旨在调查医院和医疗机构对接受直接口服抗凝剂治疗（DOAC）患者围手术期管理的当前意见，并讨论临床实践建议。
设计了一份包含13个主题和多个有序多分类子项目的问卷，发送给奥地利、瑞士和德国的120个口腔颌面外科科室，以及德国汉堡医疗机构的85名口腔颌面/口腔外科医生。数据采用卡方检验、费舍尔精确检验和琼克尔-特普斯特拉检验进行统计学评估。
回复率为42%。37%的受访者报告每年治疗超过50例接受DOAC治疗的患者，只有18%的受访者评估出血风险高[维生素K拮抗剂（VKA）为33%]。相比之下，62%的受访者会在拔牙时中断DOAC治疗，而94%的受访者会继续VKA治疗。临床医生使用缝线的比例明显高于医疗机构的医生。额外止血措施的使用在诊所和医疗机构之间有所不同。明显需要更详细的指南。
本研究显示了目前对接受DOAC治疗患者围手术期管理的意见。由于不同机构的治疗策略差异很大，因此几乎无法进行并发症分析，需要在可控条件下进行多中心研究，以更安全地治疗抗凝患者。
